### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAID# : 2802 0 DATE : 1/1 5 ADDRESS : 262 3 GRAN TS T REMEDIATIO N CONTRACTOR : PRUDEN TTECHNOLOGIES . INC . YEAR : 201(> 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S d PR E AN D POS TVIDE O O F PORPERT Y(DVD ) d EXECUTIV E SUMMAR Y e f EPA-PROVIDE D PROPERT YSKETC H d SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y d RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R TO REPLACE PLANTS , ETC. ) d CONFIRMATIO N DAT A d PHOTOGRAPH S d AS-BUIL TSKETC H d SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R H PROPERT YCLOSE-OUTCHECKLIS TSIGNE D B YEP A n DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A d UTILIT YCLEARANCE S d PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E D 

# a n 9 ^ % SIGNATUR E ^ 

## t/'j " DAT E 

### 3021760 9 

# lIMi Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 262 3 GRANT S T A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : B 2 = 11 2 PP M @ 6" ; E A = 5 8 PP M @ SCRAP E(~1" ) ATTACHMENT S 1 ) Property sketc hprovide db y EPA pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Built sketc h­ i ) Shal l includ e fina l leadlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include di n th e individual property file , i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOCIES . INC .Fin d Record 

### Backfill :

Sampi e Area : 2802 0 - 262 3 GRAN TS T Owner : n Owne rOccupie d Owne rName : JMORELL O BERNAR D J Owne rAddressl : 

# 1 Owne rAddress2 : 11141 3 HICKOR YR D City : lOMAH A State : 

### |N E Zi p Code : |68144 - Owne rPhon e 1(402 ) 342-282 0 

# 1 Alternat e Phone :

Contract : Contractor : |PRUDENT2010_S Contrac t Optio n |OFnO N 1 Remediatio n QueryI Lea d Remainin g Query| Propert yDamag e Quer y

Use rProvide d Owne rInformatio n Owne rName : 

# 1 Owne rAddress : 

# 1 City : State : Zi p Code : 

# 1 1 1 Owne rPhone : Alternat e Phone : 

# I 

# " 1

Assessment : Qualifyin g Grou p J46 b Assessmen t MaxXR F Valu e ) 524.1 2 Resident : Residen t Name : 

# I Propert yAddress : |262 3 GRAN TST Zi p Code : J68111 - Residen t Phon e 

# ITECHNOLOGliisrtNC . 

# EP A Propert y Clos e Ou t Propert y #:^9-OZ 0 Propert y Address : 2-632./ " (STOW K y ^ . Date/Time : Owner' s Name : g^rtjir ^ ^v^liC ) Quad s Excavated ; 92- ^ Contracto r Group : Pruden t Technologies , Unc , Excavatio n Genera l Ye s N o 1 .

I f necesscirv . wer e th e correc l qiiadrant(s ) excavate dan drestored ? / 2 .I f necessary- , wer e th e correc t area s o f dri p zon e excavate dan drestored ? / Gradin g So dan dVegetatio nYe s N o 1 .Doe s th e gradin g aroun dtli e perimete r o f th e hous e i n excavate darea s generall y slop e awa y / fromIh e house ? 2 .Ha s so dbee n laj di n al l area s that wer e excavated ? / 3 .

Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e if inspecte dat a3 0 / da

y Inn e period ) 4 Ar e sodde darea s generall y finn an devenl y graded ? / 5 .

Ar c tli e joint s betwee n di e so dstrip s generall y tight ? (Onl y evaluat e if inspecte dat a3 0 day tun e penod ) 

# y 6 .Wa s th e property grade dsuc htliat wate r wil l no t poo l o ndi e property ? 

# y 7 .

Wa s daniag e t o landscapin g o r plan t material s avoided ? ^ Gates , Fence s an dRetainin g WaU s 1 . D o gate s ope n an dclos e freely ? (I f apphcable ) Ye s 

# y

N o 2 . Were ai l gate s or fence s take n dow n diuin g restoratio nactivitie s reinstalled ? (I f applicable ) 

# y 3 , Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) 4 . Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

# y 

# y Foundation , Sidin g an dGutter s J . Wa s damag e t o th e sidin g o r tri mavoided ? 2 . Wa s damag e t o tli e foundatio n avoided ? 3 Wa s damag e t o window s avoided ? Ye s 

# y y 

# y N o

4 . Wa s daniag e t o window s o r doo r screen s avoided ? 5 . Wa s daniag e l o downspout s o r downspou t extension s avoided ? 

# y y Sidewalk s an dDrivcw;ty s (Concrete ) I Wa s damag e t o drivewa y surface s avoided' ? Wa s damag e t o walkwa y surface s avoided ? Ye s / 

# y

^ N o

## Owner s consinents :

Inspectio n notes :

Remova l an drestoratio n activate s complete includin g th e 30-da y sodw^arranty : EP A Representativ e ^" ^ J ^ Date : a\t\^oI'HNOLOGIES , INC 

## A S - BUIL T DRAWIN G OL S #2802 0 Dat e Excavated : IO/O.S/201 0 rSEP A Signed-Of f Date : 

## OMAHA LEAD SUPERFUND SI T 2802 0 Exterio rPain t NoithAmw Omah a Lea d Sit e Owne rName : BERJWi p J MpRELL O • Goo d Sit e Sketc h Address : 262 3 GRAN TS T • Poo r

Phone : H : 402-342-282 0 W ; g^No t pain t 

# 1.

Lea d Sampl e Sample s Collecte d Sampl e Numbe r I.A B Concentratio n Collecte d Firm : _E35_m/££ _ RYASCPXA-2802 0 F l M q pp m 

### D Date: O'i J P M Jo b RYBSCPXA-2802 0 F 2 Time : V •'J 6 /r/77 . RYCSCPXA-2802 0 B l 

### .32, 3 pp m D Sample s Analyze d RYDSCPXA-2802 0 B 2 

### SI H pp m D RDZ6CPX A2802 0 -D Z pp m 

### D D XR F Unit : Ji22_

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### D D Date : '^-31-0 ^ RPgSGPX A2802 0 -Pi
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### D D Time : Al ^ la b RYBSCPLA-2802 0 Staff : i^u J Numbe ro f Sample s = M ­ -Resul t 80. 3 pp m Legena : r1 = rio m Leu , n . - Fron t Right . 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a s viewe d fro m th e £tidet . fadn g propert y 

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A = .S S PP M (a } SCRAP E(~l" ) CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# SEP A Propert yCompletio n Agreemen t Thi s agreemen t documents the completionof remova l activitie s performe do n the below listedproperty . Th e propert y owner' s signatur e indicate s tha t the propert y owne r i s satisfiedwit hthe restoration of the subject property , an dtha t no items ar e i n question , now , o r a

t an y tim e i n the future , excluding an y remaining warrant y (3 0 day s total ) except thos e items listedbelow , i f any . Property ID : Propert y Address : £ ) f . Q Q . OKO.. . i t 

# 9 ^ Owner : Phone : Restoratio n Hems i n Question :

item : Item : Item : Item : Item : Item : Require d correction s t o complet e th e property :

I agre e restoratio n i s completed . L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )

s Signatur e yDat ePruden t Technologies , Inc . (Prudent ) i s unde r contrac t withth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o cleanu p lead
aontaminate dsoil s a t anumberfl f propertie s locate din Omaha , Nebraska , includin g th e property locate da t /-t o 2- ^ Ct/yPLy ^ T "^ ^ Th e EP A request s you r permissio nt o allo w Pruden t t o performasoi l cleanu p a t thi s property t o reiflov e lead-contaminate dsoil . B y signin g thi s form , th e property owne r grant s pennissio nt o Pruden t t o perfon n activitie s relate dt o th e cleanu p includin g soi l sampling , remova l o f lead-contaminate dsoil , an drestoratio n o f th e reference dproperty . Ifyo u hav e an y question s abou t th e soi l cleanu p planne dfor you r property , pleas e contac t Pruden t southoffic e for th e Omah aLea d Site cleanup-a t (402 ) 733-1188 . Genera l question s abou t th e Omah aLea dSite cleanu p can b e directe dt o th e EP A Publi c Informatio n Center s a t (402 ) 731-304 5 (SouthOmali aoffice ) or (402 ) 991-958 3 (NorthOmah aoffice) . Property Acces s Grante dBy : ^ ^ < A I A ^ fyiO/^€'LU i Tf

^ _/-Pio.o. ; Prijj l Name ) Property Owne r Signatur e (Date ) PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r — pleas e print ) RESIDEN TNAME : 

## \[ci^ C nn V U I r Rente r RESIDEN TADDRESS : 

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Cr£ i yC^<^o^n ^ .^J ^ I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : ^ 0 2. ) 3 7^ ' J - 6 X ^ WORK : ( ) 

### .AJ/A - AG E O F HOME? : 

# £/A . YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 5 HOUR S O R MOR E PE R WEE K COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. ) 

## A^/ A

AUTHORTT Y FO RENVIRONMENTA LRESPONS EACTIONS ; Th e activitie s t o b e implemente db y EP A unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e propert y i s provide dfo r i n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , o r choosin g o r takin g an y respons e actio n unde r thi s title , o r otherwis e enforcin g th e provision s o f th e title. " 808 0 War d Parkway , Suit e 40 5 560 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City,'M O 6411 4 Omaha . Nebrask a 6810 7 Sa n Antonio . TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 733-118 8 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402 ) 733-188 3 Fax:(210)679-657 7ENVIRONMENTA L& CONSTRUCTIO N 

## TECHNOLOGIES , INC . SERVICE S 

# Propert y Statu s For m Address : ^^jl ^ & r aU LI r

§] ^ »«te : Phone : L ^ ^ ^ ^ . ^^^ ^ ^ ^ ^ ^ BVID : 

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Propert y Owne r Pruden t Employei Signature : Signature : 808 0 War d Parkway . Suit e 40 5 Kansa s City , M O 6411 4 Phone : (816 ) 363-370 3 

# 9/^/e ^ 560 0 S 1 0 S t Omaha , Nebrask a 6810 7 Phone : (402)733-118 8 2-Mediba l ^^24a-Medita l prive , Suit e 425 0 "" ^ Sa n Antonio , T X 7822 9 Phone : (210)822-958 8

## 2802 0 Exterio rPain t Nort h Ano w 

### Omah a l«ac t Sit e Owne rName : BERNAR D J MORELL O • Good 

### SH e Sketc h Address : ^aj^ANTST_ • Poo r Phone ; " - 402-342-282 0 W : 

# i [^No t pain t Samft o Numtie r Lea d Sample s Collecte d Concenbatio n Fir m RYASCPXA-2802 0 F l Date : RYBSCPXA-28(e O F 2 Time : RYCSCPXA-2802 0 B 1 RYDSCPXA-2802 0 B 2 Sample s Analyze d RDzecpxAagoao—6 2 XR F Uni t 907 . Book : U ^ nOZSGPX A2802 0 G 2 Date : z?-?/- ^ RPZ6CPX A2802 0 P2 - Time : A& i jLa b RYBSCPLA-2802 0 _s Resul t 80, 3 pp m Numbe ro f Sample s = Staff . i^U / Legen a ri = rroti i Leir , n - Fron t Righ t B l = Bac k Left . B 2 = Bacl < Righ t D Z = Dri p Zone , G Z = Garden , PZ = Play A S quadrant s ar a a s viewe d fro m th e street , feeing propert y 

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# A Printed : No v 30 , 201 0 www.dcgis.org/dogi shttp://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. . 

### Creat e Anothe rTicket Bac k t o ifti i Internet j Sen d Emai l



## • YOURTICKE T NUMBERI S  2605477 . Origina l Cal l Date : 9/30/1 0 Time : 12:3 4 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/04/1 0 Time : 1:0 0 p m State : N E County : DOUGLA S Place : OMAH A Address : 262 3 Street : GRAN T S T Twp : 15 NRng : 13 E Sect-Qtr : 09-S E Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : soi l lea d remediatio n projec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Compan y; PRUDEN T TECHNOLOGIE S Contac t Name ; SIV AJAMPAMA Phone : (402)733-118 8 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCAT V MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

## Servic e Are a Contac t Phon e Numbe r Utilit y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEID I Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7 MUDO l METROPOLITA N UTILITIES DISTRICT SAND Y Day : 402504782 3 Alt : 

## Emerg : 402504797 0

lof 2 9/30/201 0 12:3 4 P M

### http://www.dhon.org/irthiiitemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU. , 

## OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RICH/TRAFFI C Day : 402444719 7



## Alt : 402444516 1 Emerg : 402444516 0 0PPDGPR 5 OMAH A PUBLI C POWE RDISTRICT EL M LOCATIN G Day : 406728934 3



## Alt : 4062071494 Emerg : 888728934 3 QLNNEl C QWES T LOCA LNETWOR K EL M LOCATIN G Day : 406728934 3



## Alt : 406207149 4 Emerg : 888728934 3

2 of 2 9/30/201 0 12:3 4 P M

### CONSTRUCnO N mc . SOLUTION S 

## SIT ESAFfeT Y HAZAR D ANALYSI S 

# ^^ ^ ^c^^J^yl ^ Addres s 

# : Excavatio n Date : Crew : Backfi U Date :

Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Structure s Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n c ^ ^ 

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## Sit e Safet y Offic e Date :

m o Wmfevfomy . Suito40 5 SSOOSIOS t 424 2 Medica l Drive , Suit e 725 0 OiitiAa , NalMMk B 6010 7 Sa n Antento,T X 7822 9 ifione : (818 ) 363*370 3 Ptwne : (402)733-110 8 Phone : (2t0)822!«68 8 ^KfSIS ) 363.3711 7 Fia cf402 ) 733^68 3 Fax : (210)«T9-<57 7j.i.. . .» & J - - 5



# 4